The Changing Face of Tuberculosis Control in a Rural District of New Zealand

Abstract

SETTING: Waikato Health District (WHD), New Zealand. OBJECTIVE: To describe the changing epidemiology of TB in the WHD and the factors responsible for this. DESIGN: Descriptive epidemiological study of all notified TB cases from the WHD from 1 January 1992 to 31 December 2001. Major outcome measures were delay of diagnosis and treatment outcome. RESULTS: There were 244 cases included. Over the 10-year period, TB incidence has remained stable in the WHD. There has been a significant reduction of TB in the Maori population (from 30.3 to 12.5/100 000, P = 0.03). This has been matched by a rise in the overseas-born population (from 4.6 to 21.2/100 000, P = 0.04). Tuberculosis became a predominantly urban disease during the study period. Delay in diagnosis (>4 weeks) occurred in 85% of cases, with significantly more delays in older age groups. Use of directly observed therapy (OR 3.65, 95%CI 1.24-10.76), and being a migrant (OR 3.52, 95%CI 1.74-7.09), were significantly associated with improved treatment outcome. CONCLUSION: A significant change in the epidemiology of TB has occurred over the last decade. Tuberculosis control strategies need to be developed to effectively diagnose and treat patients from diverse cultural backgrounds. Show more